Emergency Physician Compliance with Quality Indicators of Septic Shock and Severe Sepsis in Eastern Taiwanese Community Hospital

• Published in: Journal of Acute Medicine Vol. 7; no. 4; pp. 135 - 140
• Main Authors: Liu, Chih-Chang, Hsieh, Wan-Hua Annie, Lai, Pei-Fang, Hu, Sheng-Chuan, Huang, Hui-Yi, Bih, Zen Lang
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) 台灣急診醫學會 ＆ Ainosco Press 01.12.2017; Airiti Press
• Subjects: Original; septic shock; bundled care; quality indicators; severe sepsis; quality assurance
• ISSN: 2211-5587; 2211-5595
• DOI: 10.6705/j.jacme.2017.0704.001

Background: A retrospective review was conducted, examining patient charts at a community hospital in Eastern Taiwan during a 2-year period, from April 2013 to March 2015. Aims: The goal was assessment of adherence to quality indicators (QIs) in septic shock and severe sepsis (4S status) by emergency physicians (EPs). Methods: Based on the Surviving Sepsis Campaign (SSC) guidelines, data was electronically retrieved from the Hospital Information System (HIS); and beginning in April 2014, our staff was regularly educated on this topic during monthly meetings. A Sepsis Bundle Care Set (SBCS) was also launched in September 2014. The Chi-square post hoc test was utilized in statistical analysis, setting significance at p ＜ 0.05. In patients with septic shock (n = 81) or severe sepsis (n = 572), QIs before and after educational initiatives were 36 vs. 45 and 259 vs. 313, respectively. Results: In terms of septic shock, QIs that improved significantly after education were C-reactive protein (CRP: 66.67% vs. 91.11%), arterial blood gas (ABG: 58.33% vs. 80.00%), and intravenous (IV)-fluid infusion rate (0.00% vs. 40.00%). QIs that significantly improved in the context of severe sepsis were CRP (59.46% vs. 84.66%), serum lactate (75.68% vs. 86.26%), intensive care unit (ICU) admission within 4 hours (72.97% vs. 81.79%), and IV-fluid infusion rate (0.00% vs. 18.85%). In comparing QI adherence rates by educational period subsets, two-set IV line showed significant improvement after 7 months of education, and admission to ICU within 4 hours after 4 months of education. However, most QIs associated with severe sepsis (except serum lactate and antibiotic given in 1 hour) showed significant improvement after 3 months of education. Conclusions: We concluded that there is much room to improve QI adherence rates in patients with 4S status, using educational initiatives.